1
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Čulić V. Exercise training and regression of coronary atheromatous plaques. Eur J Prev Cardiol 2024; 31:e8. [PMID: 37379581 DOI: 10.1093/eurjpc/zwad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Viktor Čulić
- Department of Cardiology and Angiology, University Hospital Centre Split, Šoltanska 1, Split 21000, Croatia
- Department of Clinical Propedeutics, University of Split School of Medicine, Šoltanska 2, Split 21000, Croatia
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2
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Dotka M, Małek ŁA. Myocardial Infarction in Young Athletes. Diagnostics (Basel) 2023; 13:2473. [PMID: 37568836 PMCID: PMC10417275 DOI: 10.3390/diagnostics13152473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Myocardial infarction (MI) in young athletes is very rare but can have serious consequences, including sudden cardiac death (SCD), an increased proarrhythmic burden in future life, and/or heart failure. We present two cases of young athletes with MI. They did not have previous symptoms, traditional risk factors, or a family history of MI. One case involves a 37-year-old male amateur athlete who experienced two MI following intense physical exertion, likely due to the erosion of an insignificant atherosclerotic plaque caused by a sudden increase in blood pressure during exercise. The second case describes a 36-year-old male semi-professional runner who collapsed at the finish line of a half-marathon and was diagnosed with hypertrophic cardiomyopathy. The heart's oxygen demand-supply mismatch during intensive exercise led to MI. Following the case presentation, we discuss the most common causes of MI in young athletes and their mechanisms, including spontaneous coronary artery dissection, chest trauma, abnormalities of the coronary arteries, coronary artery spasm, plaque erosion, hypercoagulability, left ventricular hypertrophy, and anabolic steroids use.
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Affiliation(s)
- Mariusz Dotka
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Łukasz A. Małek
- Faculty of Rehabilitation, University of Physical Activity in Warsaw, 01-968 Warsaw, Poland
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3
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Plat R, Vasile M, Roubille F, Mercier G. Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France. PLoS One 2023; 18:e0286700. [PMID: 37285371 DOI: 10.1371/journal.pone.0286700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Worldwide, the COVID-19 pandemic has been associated with an overall drop in acute coronary syndrome (ACS) hospitalizations. Additionally, there is a well-known association between ACS and socioeconomic status. This study aims to assess the COVID-19 effect on ACS admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. MATERIALS AND METHODS In this retrospective study, we used the French hospital discharge database (PMSI) to estimate ACS admission rates in all public and private hospitals in 2019 and 2020. A negative binomial regression explored the nationwide change in ACS admissions during lockdown compared with 2019. A multivariate analysis explored the factors associated with the ACS admission incidence rate ratio (IRR, 2020 incidence rate/2019 incidence rate) variation at the county level. RESULTS We found a significant but geographically heterogeneous nationwide reduction in ACS admissions during lockdown (IRR 0·70 [0·64-0·76]). After adjustment for cumulative COVID-19 admissions and the ageing index, a higher share of people on short-term working arrangements during lockdown at the county level was associated with a lower IRR, while a higher share of individuals with a high school degree and a higher density of acute care beds were associated with a higher ratio. CONCLUSIONS During the first national lockdown, there was an overall decrease in ACS admissions. Local provision of inpatient care and socioeconomic determinants linked to occupation were independently associated with the variation in hospitalizations.
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Affiliation(s)
- Rodney Plat
- Data Science Unit, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Maria Vasile
- Data Science Unit, Montpellier University Hospital, Montpellier, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Grégoire Mercier
- Data Science Unit, Montpellier University Hospital, Montpellier, France
- UMR UA11 IDESP CNRS, University of Montpellier, Montpellier, France
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4
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Pereira H. The day after the COVID crisis. Rev Port Cardiol 2023; 42:7-8. [PMID: 36567146 PMCID: PMC9780740 DOI: 10.1016/j.repc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, EPE, Almada, Portugal,Faculdade de Medicina de Lisboa, Lisboa, Portugal
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5
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Chen SM, Wang LY, Liaw MY, Wu MK, Wu PJ, Wei CL, Chen AN, Su TL, Chang JK, Yang TH, Chen C, Cheng CI, Chen PC, Chen YL. Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients-A Retrospective Propensity Score-Matched Study. Front Cardiovasc Med 2022; 9:763217. [PMID: 35498011 PMCID: PMC9039246 DOI: 10.3389/fcvm.2022.763217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308-0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Ling Wei
- Department of Nursing, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Chen
- Department of Physical Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsui-Ling Su
- Department of Physical Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jui-Kun Chang
- Department of Occupational Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching Chen
- Clinical Psychologist, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-I Cheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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6
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Akhtar N, Kamran S, Al-Jerdi S, Imam Y, Joseph S, Morgan D, Abokersh M, Uy RT, Shuaib A. Trends in stroke admissions before, during and post-peak of the COVID-19 pandemic: A one-year experience from the Qatar stroke database. PLoS One 2022; 17:e0255185. [PMID: 35324905 PMCID: PMC8947388 DOI: 10.1371/journal.pone.0255185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Several reports document a decrease in the rates of stroke hospital admissions during the covid-19 pandemic. There is very little information whether the admission rates will change as the infection is controlled. We report on our rates of admissions before, during and following the peak of covid-19 infections in a prospective database from Qatar. METHODS AND RESULTS The stroke admissions in the six months prior to COVID-19 pandemic averaged 229/month. There was a decrease to 157/month in March-June during the peak of the pandemic. In the 6 months following the peak, as covid-19 numbers began to decrease, the average numbers increased back to 192/month. There was an increase in severe ischemic strokes and decreased in functional recovery. The decreased admissions were mainly driven by fewer stroke mimics. Patients presenting with ischemic stroke or cerebral hemorrhage remained unchanged. CONCLUSIONS Fewer stroke mimics presenting to the hospital can explain the fewer admissions and poor outcome at the height of the covid-19 pandemic. The continued decrease in the number of ischemic stroke and stroke mimic admissions following the pandemic peak requires more study.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al-Jerdi
- Weill Cornell Medical College- Qatar Foundation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abokersh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - R. T. Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, Canada
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Ishaque N, Butt AJ, Kamtchum-Tatuene J, Nomani AZ, Razzaq S, Fatima N, Vekhande C, Nair R, Akhtar N, Khan K, Saqqur M, Shuaib A. Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis. J Stroke 2022; 24:65-78. [PMID: 35135061 PMCID: PMC8829489 DOI: 10.5853/jos.2021.01571] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy.Methods Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models.Results We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively).Conclusions Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.
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Affiliation(s)
- Noman Ishaque
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Asif Javed Butt
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ali Zohair Nomani
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Red Deer Regional Hospital Center, Red Deer, AB, Canada
| | - Sarah Razzaq
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chetan Vekhande
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Radhika Nair
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naveed Akhtar
- Division of Neurology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Khurshid Khan
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neurology, Trillium Health Care, University of Toronto, Mississauga, ON, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Correspondence: Ashfaq Shuaib Division of Neurology, Department of Medicine, University of Alberta, Edmonton T6G 2G3, AB, Canada Tel: +1-780-248-1660 Fax: +1-780-248-1807 E-mail:
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No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area. Neth Heart J 2022; 30:76-83. [PMID: 34978678 PMCID: PMC8721632 DOI: 10.1007/s12471-021-01650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/04/2022] Open
Abstract
In the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.
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9
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Issar N, Jayachandra A, Datta R, Swamy A, Sarkar S, Aggarwal V. Profile of acute coronary syndromes in serving personnel presenting to a field cardiology center without cath lab facilities. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_40_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Pereira H, Naber C, Wallace S, Gabor T, Abdi S, Alekyan B, Alexander T, Artucio C, Batista I, Candiello A, Delport R, Luca LD, Erglis A, Farto-Abreu P, Huang WC, Kanakakis J, Lee M, Mohamed A, Orlić D, Orti P, Sobh M, Shokry K, Terzic I, Win K, Piek J. [Stent-Save a Life international survey on the practice of primary percutaneous coronary intervention during the COVID-19 pandemic]. Rev Port Cardiol 2021; 41:221-227. [PMID: 34975228 PMCID: PMC8709833 DOI: 10.1016/j.repc.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/11/2021] [Indexed: 12/15/2022] Open
Abstract
Aim To assess the impact of the COVID-19 pandemic on admissions of patients with acute coronary syndromes (ACS) and primary percutaneous coronary intervention (PPCI) in countries participating in the Stent-Save a Life (SSL) global initiative. Methods and Results We conducted a multicenter observational survey to collect data on patient admissions for ACS, ST-elevation myocardial infarction (STEMI) and PPCI in participating SSL member countries through a period during the COVID-19 outbreak (March and April 2020) compared with the equivalent period in 2019. Of the 32 member countries of the SSL global initiative, 17 agreed to participate in the survey (three in Africa, five in Asia, six in Europe and three in Latin America). Overall reductions of 27.5% and 20.0% were observed in admissions for ACS and STEMI, respectively. The decrease in PPCI was 26.7%. This trend was observed in all except two countries. In these two, the pandemic peaked later than in the other countries. Conclusions This survey shows that the COVID-19 outbreak was associated with a significant reduction in hospital admissions for ACS and STEMI as well as a reduction in PPCI, which can be explained by both patient- and system-related factors.
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Affiliation(s)
- Hélder Pereira
- SSL Europe, Hospital Garcia Orta, Almada, Portugal and Lisbon School of Medicine of the University Lisbon, Portugal
| | - Christoph Naber
- SSL Chairman, Klinikum Wilhelmshaven GmbH, Wilhelmshaven, Germany
| | | | - Tóth Gabor
- SSL Europe, University Heart Center Graz, Medical University of Graz, Austria
| | - Sayfollah Abdi
- SSL Iran, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bagrat Alekyan
- SSL Russia, Academician of the Russian Academy of Science, A.V. Vishnevsky Institute of Surgery, Moscow, Russia
| | | | - Carolina Artucio
- SSL Uruguay, Instituto de Cardiología Intervencionista de Casa de Galicia, Montevideo, Uruguay
| | - Ignacio Batista
- SSL Uruguay, Centro Cardiológico Americano, Montevideo, Uruguay, Hemodinamia del Litoral, Salto, Uruguay
| | - Alfonsina Candiello
- SSL Argentina, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Rhena Delport
- SSL South Africa, Department of Family Medicine, Steve Bico Academic Hospital, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Leonardo De Luca
- SSL Italy, Dept of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Andrejs Erglis
- SSL Latvia, University of Latvia, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Wei-Chung Huang
- SSL Taiwan, Department of Critical Care Medicine, Kaohsiung Veterans General Hospital and Department of Physical Therapy, Fooyin University, Kaohsiung, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - John Kanakakis
- SSL Greece, Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece
| | - Michael Lee
- SSL Asia, Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | | | - Dejan Orlić
- SSL Serbia, Cardiology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Patricio Orti
- SSL Mexico, Instituto Nacional de Cardiología "Ignacio Chávez", Cardiosur, Instituto Cardiovascular Cuernavaca, Medica Sur, Mexico
| | - Mohamed Sobh
- SSL Egypt; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Shokry
- SSL Egypt, Dean of Military Faculty of Medicine, Cairo, Egypt
| | - Ibrahim Terzic
- SSL Bosnia and Herzegovina, President of WG of Interventional Cardiology, Bosnia and Herzegovina, Cardiocenter Terzic, Tuzla, Bosnia and Herzegovina
| | - Kyaw Win
- SSL Maynmar, Upper Myanmar Heart Centre, Mandalay, Myanmar
| | - Jan Piek
- SSL Co-chairman, Academisch Medisch Centrum Universiteit van Amsterdam - AMC Heart Center, Amsterdam, Holland
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11
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de Koning ER, Boogers MJ, Bosch J, de Visser M, Schalij MJ, Beeres SLMA. Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands. Neth Heart J 2021; 29:224-229. [PMID: 33599968 PMCID: PMC7890775 DOI: 10.1007/s12471-021-01545-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 01/14/2023] Open
Abstract
Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns. Supplementary Information The online version of this article (10.1007/s12471-021-01545-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E R de Koning
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - M J Boogers
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Bosch
- Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
| | - M de Visser
- Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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12
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Schlachetzki F, Wilfling S, Hubert ND, Wagner A, Haberl RL, Linker RA, Hubert GJ. Decline and Recurrence of Stroke Consultations during the COVID-19 Pandemic Lockdown Parallels Population Activity Levels. Cerebrovasc Dis 2021; 50:317-325. [PMID: 33540410 PMCID: PMC7900457 DOI: 10.1159/000514154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background The COVID-19 pandemic lockdown (CPL) lead to a significant decrease in emergency admissions worldwide. We performed a timely analysis of ischemic stroke (IS) and related consultations using the telestroke TEMPiS “working diagnosis” database prior (PL), within (WL), and after easing (EL) of CPL. Methods Twelve hospitals were selected and data analyzed regarding IS (including intravenous thrombolysis [intravenous recombinant tissue plasminogen; IV rtPA] and endovascular thrombectomy [EVT]) and related events from February 1 to June 15 during 2017–2020. In addition, we aimed to correlate events to various mobile phone mobility data. Results Following the significant reduction of IS, IV rtPA, and EVT cases during WL compared to PL in 2020 longitudinally (p values <0.048), we observed increasing numbers of consultations, IS, recommendations for EVT, and IV rtPA with the network in EL over WL not reaching PL levels yet. Absolute numbers of all consultations paralleled best to mobility data of public transportation over walking and driving mobility. Conclusions While the decrease in emergency admissions including stroke during CPL can only be in part attributed by patients not seeking medical attention, stroke awareness in the pandemic, and direct COVID-19 triggered stroke remains of high importance. The number of consultations in TEMPiS during the lockdown parallels best with mobility of public transportation. As a consequence, exposure to common viruses, well-known triggers for acute cerebrovascular events and other diseases, are reduced and may add to the decline in stroke consultations. Further studies comparing national responses toward the course of the COVID-19 pandemic and stroke incidences are needed.
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Affiliation(s)
- Felix Schlachetzki
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany,
| | - Sibylle Wilfling
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Nikolai Dominik Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
| | - Andrea Wagner
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Roman L Haberl
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
| | - Ralf Andreas Linker
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Gordian Jan Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
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Schlachetzki F, Theek C, Hubert ND, Kilic M, Haberl RL, Linker RA, Hubert GJ. Low stroke incidence in the TEMPiS telestroke network during COVID-19 pandemic - effect of lockdown on thrombolysis and thrombectomy. J Telemed Telecare 2020; 28:481-487. [PMID: 32811274 PMCID: PMC7441481 DOI: 10.1177/1357633x20943327] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background During the COVID-19 pandemic emergency departments have noted a significant decrease in stroke patients. We performed a timely analysis of the Bavarian telestroke TEMPiS “working diagnosis” database. Methods Twelve hospitals from the TEMPiS network were selected. Data collected for January through April in years 2017 through 2020 were extracted and analyzed for presumed and definite ischemic stroke (IS), amongst other disorders. In addition, recommendations for intravenous thrombolysis (rtPA) and endovascular thrombectomy (EVT) were noted and mobility data of the region analyzed. If statistically valid, group-comparison was tested with Fisher’s exact test considering unpaired observations and ap-value < 0.05 was considered significant. Results Upon lockdown in mid-March 2020, we observed a significant reduction in recommendations for rtPA compared to the preceding three years (14.7% [2017–2019] vs. 9.2% [2020], p = 0.0232). Recommendations for EVT were significantly higher in January to mid-March 2020 compared to 2017–2019 (5.4% [2017–2019] vs. 9.3% [2020], p = 0.0013) reflecting its increasing importance. Following the COVID-19 lockdown mid-March 2020 the number of EVT decreased back to levels in 2017–2019 (7.4% [2017–2019] vs. 7.6% [2020], p = 0.1719). Absolute numbers of IS decreased in parallel to mobility data. Conclusions The reduced stroke incidence during the COVID-19 pandemic may in part be explained by patient avoidance to seek emergency stroke care and may have an association to population mobility. Increasing mobility may induce a rebound effect and may conflict with a potential second COVID-19 wave. Telemedical networks may be ideal databases to study such effects in near-real time.
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Affiliation(s)
- Felix Schlachetzki
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, TEMPiS Telemedical Stroke Center, Regensburg, Germany
| | | | - Nikolai D Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
| | - Mustafa Kilic
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, TEMPiS Telemedical Stroke Center, Regensburg, Germany
| | - Roman L Haberl
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, TEMPiS Telemedical Stroke Center, Regensburg, Germany
| | - Gordian J Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
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14
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Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography. J Interv Cardiol 2020; 2020:8263923. [PMID: 32774188 PMCID: PMC7395998 DOI: 10.1155/2020/8263923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. Results Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41–63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36–46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. Conclusions OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.
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Huet F, Prieur C, Schurtz G, Gerbaud E, Manzo-Silberman S, Vanzetto G, Elbaz M, Tea V, Mercier G, Lattuca B, Duflos C, Roubille F. One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic. Arch Cardiovasc Dis 2020; 113:303-307. [PMID: 32362433 PMCID: PMC7186196 DOI: 10.1016/j.acvd.2020.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/23/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is likely to have significant implications for the cardiovascular care of patients. In most countries, containment has already started (on 17 March 2020 in France), and self-quarantine and social distancing are reducing viral contamination and saving lives. However, these considerations may only be the tip of the iceberg; most resources are dedicated to the struggle against COVID-19, and this unprecedented situation may compromise the management of patients admitted with cardiovascular conditions. Aim We aimed to assess the effect of COVID-19 containment measures on cardiovascular admissions in France. Methods We asked nine major cardiology centres to give us an overview of admissions to their nine intensive cardiac care units for acute myocardial infarction or acute heart failure, before and after containment measures. Results Before containment (02–16 March 2020), the nine participating intensive cardiac care units admitted 4.8 ± 1.6 patients per day, versus 2.6 ± 1.5 after containment (17–22 March 2020) (rank-sum test P = 0.0006). Conclusions We confirm here, for the first time, a dramatic drop in the number of cardiovascular admissions after the establishment of containment. Many hypotheses might explain this phenomenon, but we feel it is time raise the alarm about the risk for patients presenting with acute cardiovascular disease, who may suffer from lack of attention, leading to severe consequences (an increase in the number of ambulatory myocardial infarctions, mechanical complications of myocardial infarction leading to an increase in the number of cardiac arrests, unexplained deaths, heart failure, etc.). Similar consequences can be feared for all acute situations, beyond the cardiovascular disease setting.
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Affiliation(s)
- Fabien Huet
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - Cyril Prieur
- Department of Cardiology, Hôpital Cardiologique Louis Pradel, 69500 Bron, France
| | - Guillaume Schurtz
- Department of Cardiology, Institut Coeur Poumons, Hôpital Cardiologique, 59000 Lille, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, 33600 Pessac, France
| | | | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Meyer Elbaz
- Department of Cardiology, Hôpital Rangueil, 31400 Toulouse, France
| | - Victoria Tea
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Grégoire Mercier
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Medico-Economic Research Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Benoît Lattuca
- Department of Cardiology, CHU de Nimes, 30029 Nimes, France
| | - Claire Duflos
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France.
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